Tuesday, March 19, 2013

Bangladesh makes dramatic advances in child survival.

In 1990, the infant mortality rate in Bangladesh, 97 deaths per 1,000 live births, was 16% higher than India’s 81. By 2004, the situation was reversed, with Bangladesh’s infant mortality rate (38) 21% lower than India’s (48). 
Three main factors seem to explain the dramatic improvements. 
First, economic empowerment of women through employment in the garment industry and access to microcredit transformed their situation. The vast majority of women in the garment industry are migrants from rural areas. This unprecedented employment opportunity for young women has narrowed gender gaps in employment and income. The spread of microcredit has also aided women’s empowerment. Grameen Bank alone has disbursed $8.74 billion to 8 million borrowers, 95% of them women. According to recent estimates, these small loans have enabled more than half of borrowers’ households to cross the poverty line, and new economic opportunities have opened up as a result of easier access to microcredit. Postponed marriage and motherhood are direct consequences of women’s empowerment, as are the effects on child survival. 
Second, social and political empowerment of women has occurred through regular meetings of women’s groups organized by nongovernmental organizations. For example, the Grameen system has familiarized borrowers with election processes, since members participate in annual elections for chairperson and secretaries, centre-chiefs and deputy centre-chiefs, as well as board member elections every three years. This experience has prepared many women to run for public office. Women have also been socially empowered through participation in the banks. A recent analysis suggests much better knowledge about health among participants in credit forums than among nonparticipants. 
Third, the higher participation of girls in formal education has been enhanced by nongovernmental organizations. Informal schools run by the nongovernmental organization BRAC offer four years of accelerated primary schooling to adolescents who have never attended school, and the schools have retention rates over 94%. After graduation, students can join the formal schooling system, which most do. Monthly reproductive health sessions are integrated into the regular school curriculum and include such topics as adolescence, reproduction and menstruation, marriage and pregnancy, family planning and contraception, smoking and substance abuse, and gender issues. Today, girls’ enrolment in schools exceeds that of boys (15 years ago, only 40% of school attendees were girls). Women’s empowerment has gone hand-in-hand with substantial improvements in health services and promotion. With injectable contraceptives, contraceptive use has surged. Nearly 53% of women ages 15–40 now use contraceptives, often through services provided by community outreach workers. BRAC also provided community-based instruction to more than 13 million women about rehydration for children suffering from diarrhoea. 
Today Bangladesh has the world’s highest rate of oral rehydration use, and diarrhoea no longer figures as a major killer of children. Almost 95% of children in Bangladesh are fully immunized against tuberculosis, compared with only 73% in India. Even adult tuberculosis cases fare better in Bangladesh, with BRAC-sponsored community volunteers treating more than 90% of cases, while India struggles to reach 70% through the formal health system.

Article taken from UN HDI Report by Ms Anita Rego.

Saturday, March 16, 2013

Engaging UK Citizens in the #post2015 development agenda has important implications both home and away. Let’s take a look at Bradford…


Becca Degan, UK 



In the early years the focus remains on reducing child poverty, improved housing, improved nutrition and lifestyles for women and their children… In addition, ensuring access to free high quality early education and childcare for all children including those with disabilities remains a key focus.” 1



Reading this description of health priorities, reducing poverty, ensuring access to education for all, where would you assume the author was describing?



This is an extract from Bradford City Council’s 2012 Public Health Report. In 2010 27.1% of children in Bradford were living in poverty, compared to the national average of 21.9%. It has one of the highest rates of infant mortality across England, with the majority being from deprived areas2. A response to these statistics has seen the launch of a number of projects, including Born in Bradford, a project that has the potential to help those much further afield than Bradford due to its focus on equality.



As the post Millennium Development Goals (MDGs) are being discussed, I think child and maternal health in Bradford provide a good example of how these goals can be made truly universal. Post 2015 goals should have a greater focus on inequality and the use of disaggregated measures, committing governments to tackling inequality, in areas such as Bradford, as well as in cities and countries more traditionally considered as experiencing poverty. International development agendas could be seen as an opportunity to engage in the worldwide community to figure out and action the best ways for all of us to help those in poverty, in our own neighbourhoods, towns and cities in the UK, as well as those on other continents.

Encouraging our politicians to focus on and commit to tackling inequalities has the potential to benefit people worldwide. Inequality has been a major barrier to achieving the current MDGs, despite broad success across several goals, many of the world’s poorest or most vulnerable have made little or no development progress over the past fifteen years and inequalities are now greater than ever3.

Bradford City Council has drafted their Health and Wellbeing Strategy for 2013-2017 and there first goal is to ‘Give every child the best start in life in the Bradford district’, this is determined as important due to the high levels of child poverty and infant mortality in Bradford. Their strategy also calls for ‘a healthy standard of living for all’, stating that the gap between the richest and the poorest parts of Bradford is greater than the gap in most other Local Authority areas4.

In the post 2015 global agenda we need to address issues that are truly universal, working together to ensure that those across the globe who are most vulnerable are not forgotten about and left behind, regardless of whether they live in a rich or poor nation. These goals should be and could be used by citizens in the UK as well as globally to pressure our governments to achieving goals that have been internationally ratified.



References:


About the author:

Having recently completed an MA in Globalisation and Development I am looking to develop my knowledge of global issues, to try and influence policy makers on topics that I am passionate about. I currently work in the health sector in pursuit of a career in public health policy and am particularly interested in the role that social media has on engaging citizens with policy.



 

Saturday, March 2, 2013

FAQ: TB/HIV Co-infection



What is a co-infection?

Co-infection means infection with more than one disease at the same time. Some co-infections commonly seen in people infected with HIV include:
• HIV/hepatitis B virus (HBV) co-infection
• HIV/hepatitis C virus (HCV) co-infection
• HIV/tuberculosis (TB) co-infection
People infected with HIV should be tested for HBV, HCV, and TB.


Why risk of Tuberculosis is higher among people living with HIV than someone without HIV?

TB germs are available in the air. When we inhale air, TB germs enter in our body through air. In all likelihood, many of us may be carrying the TB germ inside our body in inactive state. We don’t get the Tuberculosis as long as our body immune system which protects us from diseases remains strong.  When HIV damages the body immune system, the TB germ in the body becomes active and causes Tuberculosis.


Why is the risk of tuberculosis/TB higher among people with HIV?

TB germs are released in air when a TB patient coughs or sneezes. When we inhale air, TB germs enter in our body through air. In all likelihood, many of us may be carrying the TB germs inside our body.  Our body’s immune system, which protects us from the diseases keeps the TB germs inactive and prevents Tuberculosis.HIV damages body’s immune system and weakens it.  The weak immune system cannot keep theTB germs inactive any more. The TB germs become active and cause Tuberculosis.
The chance of getting TB in lifetime is around 10% in a person not infected by HIV. The chance of getting TB increases up to 50 – 60% after one is infected with HIV.


If I have HIV, when I should suspect that I may have Tuberculosis?

If one has HIV and develops any one of the symptoms of any duration like cough, fever, loss of weight, loss of appetite or sweats at night, Tuberculosis should be suspected.


How do I protect myself from Tuberculosis, if I have HIV?

a.       Know about the Tuberculosis symptoms; if you have any one of the symptoms, please visit to the TB clinic of the local public hospital or health centre. Similarly know in details where in your locality free services of TB diagnosis and treatment available in the public health system.
b.      It is advised to take Isoniazid (INH) tablet daily.This is known as INH Prophylactic Treatment (IPT). IPT prevents Tuberculosis in people living with HIV.
c.       If you are already taking Antiretroviral Treatment (ART), you should adhere to the treatment. ART reduces the chances of Tuberculosis in people living with HIV by protecting the immune system which prevents the already existing TB germ in the body from causing Tuberculosis.
d.      Always cover your mouth whenever you cough or sneeze to stop shedding TB germs into the environment and advise your friends and relatives to do the same.


If I am infected by HIV and suspect to have TB symptoms what should I do?

Please visit immediately to the near-by DMC (Designated Microscopy Centre) and get yourself evaluated for TB by the Medical Officer of DMC. Don’t waste any time by visiting private doctors or pharmacists and avoid self-medication.


Why TB patients are advised to go for HIV counseling and testing?

Almost 5% of the TB cases of India are infected by TB, which means for every 20 TB cases 1 person is infected by HIV. The death rate among HIV-infected TB cases is as high as 14% in India when the same in HIV-uninfected TB cases is 2-3%. But early diagnosis of HIV in TB cases will help the person to seek HIV care and treatment on time which will decrease chances of relapse of TB and premature death by TB in people living with HIV.
This is why all the newly diagnosed TB cases are advised to go for HIV counseling & testing.

 
How HIV care on time can reduce chances of relapse of TB and death by TB in people living with HIV?

TB is the commonest opportunistic infections and also the major killer of people living with HIV. In India, a person living with HIV has chance of having TB disease 50 – 60% in his life time while the same is only 10% for a HIV-negative individual. TB is estimated to cause one in four deaths among PLHIV in India.
 WHO has recommended to initiative Anti Retro-Viral Treatment (ART)[1] to all HIV-infected TB cases even without evaluating the CD4 count[2]. ART improves the CD4 count in the body which further decreases occurrence of opportunistic infections[3] in the person living with HIV including TB.


Can a person infected by HIV and affected by TB take both ART and ATT (Anti-TB Treatment) together?

Yes, the person can take both ART & ATT together under strict medical supervision. The Medical Officer of ART centre is the best person to guide you in this regards.


If a person is infected by HIV and affected by TB and not on ART, which medications should start first?

The TB medications should be started as soon as the diagnosis of TB is confirmed. Once ATT is well-tolerated by the person, ART should be initiated (generally 2-4 weeks after ATT).


What else a person who is infected by HIV and affected by TB should take other than ATT & ART?

The person should also take CPT (Co-trimoxazole Prophylactic Therapy) to prevent pneumonia caused by other opportunistic organisms.


Can DOTS be equally effective for treating TB in persons living with HIV and affected by TB?

Scientific evidences prove that DOT is equally effective to treat and cure TB in people living with HIV if treatment adherence is strictly followed.


How TB disease enhances progress of HIV in the body?

In a TB/HIV co-infected person, the immune response to TB bacilli increases HIV replication. As a result of the increase in number of viruses in the body, there is rapid progression of HIV infection. The viral load can increase by 6-7 folds. As a result, there is a rapid decline in CD4 count and patient starts developing symptoms of various opportunistic infections. Thus the health of the patient who has dual infection deteriorates much more rapidly than with a single infection. Amongst the AIDS cases, TB is the most common opportunistic infection. The mortality due to TB in AIDS cases is also high.


What are the differences of manifestation of TB in different stages of HIV infection?

Early stage (when CD4 count is normal): TB is mostly Pulmonary Sputum Smear Positive TB
Late stage (when CD4 count is below normal): Pulmonary Sputum Smear Negative TB and Extra-Pulmonary TB.


Why TB services should be integrated with HIV prevention program? (Collaboration between Targeted Intervention and RNTCP)

HIV prevention programs (known as Targeted Intervention) aims to prevention of HIV transmission in HIV high risk groups namely sex workers, IDUs, migrants and truckers. Different studies revealed that these groups are equally vulnerable to TB not only because of co-infection with HIV but also due to socio-economic factors like poverty, unhealthy life-style in crowded and poorly-ventilated places, effects of drugs, malnutrition and migration. This is why the HIV prevention programs covering these groups should be integrated with TB services to provide them TB/HIV service packages within the same strategy and intervention cost-effectively.

Universal Health



[1] Antiretroviral medicines prevent multiplication and spread of HIV in the body. After antiretroviral treatment is started, HIV can’t destroy CD4 cells like before and the CD4 count gradually rises. Usually, the CD4 test is used to determine when a person living with HIV should start the antiretroviral treatment. After antiretroviral treatment is started CD4 count is repeated time to time to know the progress achieved after the treatment.  The CD4 count is measured by a simple blood test and is reported as the number of CD4 cells per cubic millimetre of blood. People those are not infected by HIV have CD4 counts between 600 and 1200 CD4 cells per cubic millimetre of blood. People living with HIV have CD4 counts less than 500, and people who have developed AIDS can have CD4 count 200 cells per cubic millimetre or fewer.



[2] CD4 are cells in the body that protect from disease producing germs such as bacteria and viruses and prevent occurrence of diseases. CD4 count is a measurement of how many CD4-cells is circulating in the blood. Once a person is infected by HIV, HIV destroys the CD4 cells in the body and his/her CD4 count gradually falls. As CD4 count falls, the immune system of the body starts losing the power to fight against the disease producing germs. The lowering of CD4 count indicates weakening of the immune system. Improving the CD4 count and strengthening the immune system of the HIV infected person is of critical importance; otherwise he/she may be affected by life-threatening condition of AIDS.


[3] There are disease-producing germs which remain within our environment and also inside our body. In normal condition they cannot produce any diseases because our healthy immune system easily fights them off.  These germs produce diseases when the immune system is damaged and weakened by HIV. We call these diseases ‘Opportunistic Infections’ as these germs find the weak immune system the opportunity to cause diseases.